Male Infertility Treatment
Treatments
Oligoasthenospermia
Cause of explained infertility
  • Varicocele
  • A doctor will perform varicocelectomy if varicocele is confirmed by physical examination or scrotal ultrasound. At this moment, the patient may decide whether to proceed with artificial insemination or IVF based on his spouse’s age and cause of infertility. There are many techniques available but inguinal or subinguinal microsurgical approach has been popular because it not only prevents complications such as testicular atrophy, scrotal edema, and hydrocele by preserving arteries and lymphatic ducts but also reduces the rate of relapse. Improvement in seminal parameters is demonstrated in approximately 70% of patients after surgical varicocele repair. Improvements in motility are most common, occurring in 70% of patients, with improved sperm densities in 51% and improved morphology in 44% of patients. Conception rates have averaged 40% to 50%.
Hormonal imbalance
  • Kallmann syndrome(congenital hypogonadotropic hypogonadism)
    It can be very effectively treated with hCG(Human chorionic gonadotropin) and hMG(human menopausal gonadotropin) therapy. They will be administered 3 times a week for treating a severe oligospermia and azoospermia.
  • Imbalance of male and female hormones
    Normally a man shows male hormones 15 times higher than female hormones but some may show the level of hormones as low as 10 times. In this case, a doctor can prescribe Arimidex tablet which is a female hormone suppressant.
  • Unexplained male hormone deficiency
    Hormonal medications such as clomiphene or HCG (Human chorionic gonadotropin) are used as an empirical method, yet less than half of men achieve effective results.
Cause of unexplained infertility
  • Life style modification for better sperm quality
  • A patient should quit smoking or drinking alcohol and start regular exercise. It is necessary to avoid places with high temperature (such as a sauna or workplace). Try this method for 3~6 months and take semen analysis again.
  • Use of antioxidants
  • A patient may take vitamin C, E, glutathione, and zinc to get rid of reactive oxygen species and to increase the possibility of pregnancy.
  • Artificial insemination or IVF
  • If there is no specific cause found or none of the methods above is effective, artificial insemination or IVF can be considered.
Azoospermia
Obstructive azoospermia
Microsurgical correction is possible for the case of vasovasotomy (for blocked vas deferens) or vasoepididymostomy (for blocked epididymis). The chances that sperm will appear in semen sample are above 90% in vasovasostmy and around 60% in vasoepididymostomy for respective surgeries. For a blocked ejaculatory duct, transurethral resection of ejaculatory duct(TURED) will be used.

If surgical correction is impossible, sperm can be obtained from epididymis or testis. Using a technique called Intracytoplasmic Sperm Injection (ICSI), IVF will be carried out, which shows 40% of success rate. Any remaining sperm or testicular tissue can be cryopreserved for the next IVF cycle.
Non-obstructive azoospermia
In the past, a man with testicular dysfunction had no choice but to adopt a baby or use a sperm bank to father a child. The rise of assisted reproductive technology such as Intracytoplasmic Sperm Injection (ICSI), however, allows a man to establish pregnancy as long as at least a single sperm can be found in his testis. These days, the advanced microsurgical method only targets a selected area to get successful sperm retrieval with increased efficiency and lessens damages on testicles.


    Micro-TESE(microdissection testicular sperm extraction)
    - sperm retrieval method for non obstructive azoospermic patient by using microscope.
    - whitish looking testicular tissue is normal under microscopic field.
Sperm DNA Fragmentation
The most urological problems causing damage on sperm DNA are varicocele, urogenital infection, high fever, air pollution, smoking and age, which are all closely related to the overproduction of reactive oxygen species. The damage on the spermatid nucleus is known to have a negative influence on both natural birth and artificial insemination or IVF.
Thus, proactive approach to figure out the cause of Sperm DNA damage and correct the problem for the male infertility patient with a high risk of damaged sperm nucleus. Among many reasons causing sperm DNA fragmentation, varicocele, urogenital infection, smoking and air pollution can be corrected. Along with surgical corrections of varicocele, antioxidant medication and inflammation treatment can be applied for some DNA-damage-inducing causes.
Genetic Consultation
With the development of Intracytoplasmic Sperm Injection (ICSI), only a couple of sperm is required to establish pregnancy. It allows a man who suffers from infertility to father a child; however, some genetic abnormalities are freely transmitted. Most commonly known diseases are sex chromosome abnormality and microdeletion in Y chromosome.
Therefore, a thorough consultation is required before proceeding with an artificial insemination if any anomalies are found in a man. Through preimplantation genetic diagnosis (PGD), a couple can also consider transferring only female embryos.